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The Turnaway Study

Ten Years, a Thousand Women, and the Consequences of Having—or Being Denied—an Abortion

“If you read only one book about democracy, The Turnaway Study should be it. Why? Because without the power to make decisions about our own bodies, there is no democracy." —Gloria Steinem

“Dr. Diana Greene Foster brings what is too often missing from the public debate around abortion: science, data, and the real-life experiences of people from diverse backgrounds…This should be required reading for every judge, member of Congress, and candidate for office—as well as anyone who hopes to better understand this complex and important issue.” —Cecile Richards, cofounder of Supermajority, former president of Planned Parenthood, and author of Make Trouble

A groundbreaking and illuminating look at the state of abortion access in America and the first long-term study of the consequences—emotional, physical, financial, professional, personal, and psychological—of receiving versus being denied an abortion on women’s lives.

What happens when a woman seeking an abortion is turned away? Diana Greene Foster, PhD, decided to find out. With a team of scientists—psychologists, epidemiologists, demographers, nursing scholars, and public health researchers—she set out to discover the effect of receiving versus being denied an abortion on women’s lives. Over the course of a ten-year investigation that began in 2007, she and her team followed a thousand women from more than twenty states, some of whom received their abortions, some of whom were turned away.

Now, for the first time, the results of this landmark study—the largest of its kind to examine women’s experiences with abortion and unwanted pregnancy in the United States—have been gathered together in one place. Here Foster presents the emotional, physical, and socioeconomic outcomes for women who received their abortion and those who were denied. She analyzes the impact on their mental and physical health, their careers, their romantic lives, their professional aspirations, and even their existing and future children—and finds that women who received an abortion were almost always better off than women who were denied one. Interwoven with these findings are ten riveting first-person narratives by women who share their candid stories.

As the debate about abortion rights intensifies, The Turnaway Study offers an in-depth examination of the real-world consequences for women of being denied abortions and provides evidence to refute the claim that abortion harms women. With brilliant synthesis and startling statistics—that thousands of American women are unable to access abortions; that 99% of women who receive an abortion do not regret it five years later—The Turnaway Study is a necessary and revelatory look at the impact of abortion access on people’s lives.

Amy AMY
I just couldn’t imagine starting over and doing it all again. I would be depriving my first child by having to support a second one.

I was born in Texas, and I lived there with my mom and my dad. My mom worked in a nursing home. My dad was a mechanic. They divorced when I was a little kid. My parents are remarried and have their own families now. So we’re still here in Texas.

When my parents got divorced, it really wasn’t the best time for a kid. So I don’t really remember a whole lot other than my grandparents, who had a farm. You know, there was lots of animals. But my parents were both very good parents. I can remember they were good.

My husband and I, we’ve been together since high school. We had just got married when I became pregnant. When we found out that I was pregnant with our first child, our only child, I was 17, and we had considered adoption. Well, we had picked out a family, and she actually went there for about two weeks until we changed our mind. We had thought, you know, if we couldn’t give her the life that she deserved, then we’ll give somebody else the opportunity to. We had signed the papers and everything that we were supposed to do. And she was with the family. It was so sad. I tried to separate the postpartum blues from my own emotions. And then I realized it’s not postpartum. This is our child. We need to get her back and raise her even if we have to struggle or we have to sacrifice different things. We’ll make it work. So we got her back.

We were just living the American dream and just living one day at a time and trying to raise a daughter the best we could. We talked about having more kids when our daughter was younger. My husband would say, “You know, we should have one more.” And first I was like, “Yeah, well, when she’s four.” And then I was like, “Okay, when she’s five or when she’s six or when she’s seven.” And then it just became—there’s really no point in starting over. She’s in school and there was no time, no room, no money, no nothing for an extra mouth to feed. Every marriage has its challenges. Was it anything out of the ordinary? No. We were just like any other married couple, I guess.

I was living with my husband and my daughter when I became pregnant again. At that time I was coaching figure skating and my daughter was ten. I was working, and living life, and stuff happens and there you are. We have to make decisions.

We weren’t struggling, but we had recently bought a house. My daughter was a figure skater, which was quite expensive. It was a good chunk of money each month to do that. And we were planning to send her to a private school. I felt like I wanted to give one kid everything that I possibly could. I couldn’t fathom giving two children all the things that I wanted to be able to give one.

When I found out I was pregnant again, I had mixed emotions. I was kind of scared, like, okay, what are we going to do? Sad because I already knew that I never wanted any more children.

My husband was—he had mixed emotions as well. He couldn’t believe that it had happened, because even though we had the one child, she was pretty much a miracle baby because my husband cannot have children, and here we were expecting another. When he was a teenager, my husband had a medical issue. And when he got finished with his surgeries, they told him the likelihood for him to have any children would be slim to none. So our first one was a surprise because we never thought that he would ever be able to have children. So when we found out that I was pregnant the second time, it was a lot to deal with.

I remember I told my husband on his birthday that I was pregnant. And he had asked me, he said, “Well, what are we going to do?”

So, on this new pregnancy, we already knew what the options were. We already knew that adoption wasn’t going to work. That just wasn’t in our blood. So we looked at the route of the abortion. And that just fit our plan better. When I went to my doctor, who I’d been seeing for the past ten years, she knew that I never wanted any more children, so she gave me a pamphlet, and I had to call and set up an appointment.

There were some protesters outside the clinic. There weren’t very many, and it didn’t faze me. I knew what I wanted to do, and I’m a pretty strong-willed person. So they weren’t going to change my mind. But I guess if some people were uncertain about their decision, then it could have affected them. But I just went on in. In the clinic, I was super nervous. One, you don’t want to see anybody that you know. So you just hold your head down and just get through it. We saw all types of different people there. But the staff was wonderful. They were—after you have the abortion, you’re kind of out of it a little bit, but I remember everybody being really nice and making sure that everything was taken care of properly. They kind of commended me on my bravery and were understanding and made me feel like I was making the right choice for me. When I left, everything was fine, and it was a rock lifted off my chest.

I don’t think that the abortion has affected anything since then negatively. And honestly I’m not even sure if it’s been positive, either. I think it was just something that I knew that had to be done, and we went about our lives. My husband owns his own business, and I’m working in a field that I love. I work as a medical assistant now. I remember when I was younger I would take a toy medical kit and pretend to listen to the heartbeats of my stuffed animals. So early on, I kind of had an idea that I liked health care. And here I am doing it, you know, three decades later. Our daughter has grown up with everything that I could’ve, would’ve, should’ve given her. You know, we have a house. We have a family. It’s a good life. I’m happy where I am. My daughter is a teenager. She’s a pretty big highlight of my life. I basically think that everything that I’ve ever done, ever worked for has been for her. So every moment, every day that I get to spend with her, is a highlight. Raising a teenage daughter, I’m so blessed because she’s such a good kid. It’s an ordinary life, but it’s an extravagant, wonderful ordinary life.

I never wanted any more children after I had our daughter, but she is dating a boy who came from very little. We’ve basically taken him in on our own and, you know, supported him as much as we can. And so it’s funny that I never wanted any more children, but here I am helping out another one. So it’s so funny. I tease him, “You’re the son that I never wanted.” But he’s a good kid.

When I did the studies every six months or so, they’d be like, “How often do you think about the pregnancy?” And I said, “Only when you call me.” It wasn’t something that plagued me or I thought about really much at all because I just knew that it was something that had to be done. So we just kept living.

If I hadn’t had the abortion, I’d basically be starting over, because this child would be, like, in kindergarten, first grade, and we’d be doing the same thing that we’ve already done. I just couldn’t imagine starting over and doing it all again. I would be depriving my first child by having to support a second one. And I guess being an only child myself I was really selfish, and I’m still selfish. I just want to give one person everything that I can. We’d have to buy a different house. We’d need a bigger house. Now we get to go on vacations. We’re sending our daughter off to Mexico this summer. Just things that I don’t think would be possible with a second child.

I’m glad that I did it. I don’t think that it’s a bad thing at all. I think it’s definitely a woman’s choice. That’s what I decided along with my family, and it was the best choice for us. I had the support of my husband, but I believe that it is always a woman’s choice. I don’t necessarily believe in it as a form of birth control, but it is—it’s still a woman’s choice.

My goal right now is sending the kiddo to college—a good college. Get her in and make sure she’s prepared for her own future. I want to continue to be happy. I mean, really that’s what anybody wants: Everybody just wants to be happy. And as long as we have that, I think that, to me, is a bright future. Happiness and having a supportive backbone is a pretty good goal for me.

Amy, a white woman from Texas, was 28 years old and six weeks pregnant when she had an abortion.
This reading group guide for The Turnaway Study includes an introduction, discussion questions, and ideas for enhancing your book club. The suggested questions are intended to help your reading group find new and interesting angles and topics for your discussion. We hope that these ideas will enrich your conversation and increase your enjoyment of the book.

Introduction

What happens when a woman seeking an abortion is turned away? To answer this question, Diana Greene Foster assembled a team of scientists—psychologists, epidemiologists, demographers, nurses, physicians, economists, sociologists, and public health researchers—to conduct a landmark ten-year study. They followed a thousand women from across America, some of whom received abortions, some of whom were turned away. The results were thorough and astonishing.

As the national debate around abortion intensifies, The Turnaway Study offers the first in-depth, data-driven examination of the negative consequences for women who cannot get abortions and provides incontrovertible evidence to refute the claim that abortion harms women. Interwoven with the study findings are ten first-person narratives. Candid, intimate, and deeply revealing, the stories bring to life the women behind the science. The Turnaway Study is a must-read for anyone who cares about the impact of abortion and abortion restriction on people’s lives.

Topics and Questions for Discussion

1. As Dr. Foster writes, the term “turnaway” “resonates with a whole set of issues that surround women’s decision making around pregnancy” (page 5). What are some of the issues she identifies? In your opinion, why might it be important to consider the many ways people and society “turn away” when it comes to abortion?

2. Unlike previous studies that compared women who received abortions to women who carried wanted pregnancies to term, the Turnaway Study studied women with unwanted pregnancies and compared those who received to those who were denied the abortions they sought. Why is this distinction important? How does Dr. Foster describe the advantages of the Turnaway Study’s methodology?

3. According to Dr. Foster, Amy’s in-depth interview (beginning on page 25) shows how “abortion can be a normal part of planning a family and living a meaningful life.” Dr. Foster suggests that stories like Amy’s, which are largely missing from abortion discourse, are essential to consider. Describe how Amy’s circumstances informed her decision to seek an abortion. How does a story like Amy’s contribute to a broader conversation about abortion?

4. Refer to Figure 1 on page 46. For many women who receive later abortions (20 weeks or later), difficulties finding and getting to a clinic are significant factors in delaying their care. Identify challenges and impediments to receiving care that are unique to second- and third-trimester abortions. What effect might these obstacles have on the person seeking care?

5. Dr. Foster discusses the Hyde Amendment, which restricts federal funds from paying for an abortion. What challenges does the Hyde Amendment pose to women seeking an abortion? What do you think of a restriction on abortion that only affects low-income women?

6. In the Turnaway Study, researchers asked women to rate their emotions (regret, anger, sadness, guilt, happiness, relief) with regard to their unwanted pregnancies and separately, their abortions. Women were asked about each emotion individually, allowing, for example, participants to report feeling high levels of both relief and anger. Why is it important that the questions were asked in this way?

7. The Turnaway Study found that women denied abortions had higher anxiety and lower self-esteem in the first six months but did not find differences in mental health between women who received or were denied an abortion in the long run. Were you surprised by any of the findings regarding mental health outcomes? If yes why, and what informed your prior belief?

8. Dr. Foster discusses a person’s “right to make their own personal decisions, even decisions that they might regret,” or what Katie Watson has called the “dignity of risk” (page 128). According to Dr. Foster, how is this an important concept to consider when talking about abortion, especially in light of the Turnaway Study’s findings that mental health is not adversely affected by receiving an abortion?

9. The Turnaway Study found that a woman’s existing and, should she choose to have them, future children benefit across multiple metrics when she is able to receive a wanted abortion. How does this finding add nuance to discussions of children’s well-being, with regard to abortion?

10. In chapter 9, Dr. Foster points out that, even in the wake of the Turnaway Study, “we are still talking about whether abortion harms women and not whether lack of abortion harms women and children.” In your opinion, how could reframing the question in this way affect the discourse around abortion?

11. How does Brenda’s story (beginning on page 265) of being denied an abortion illustrate the Turnaway Study’s finding that women’s concerns about having a child tend to come about, if they are made to carry the pregnancy to term?

12. In chapter 10, Dr. Foster writes, “There are more restrictions on abortion in 2020 than there were in 1973, when the U.S. Supreme Court first affirmed access to abortion as a constitutional right in Roe v. Wade.” What are some reasons she cites for this increase in restrictions?

13. As Dr. Foster points out, “many of us are alive today because our mothers and grandmothers were able to avoid carrying a prior unwanted pregnancy to term” (page 263). How does her own family history illustrate this point?

14. How is the term “reproductive justice” defined on page 280? Why is it important to specifically address the needs of marginalized persons and communities? How do abortion rights fit into a reproductive justice framework?

15. Findings from the Turnaway Study have already made their way into the courtroom, resulting in evidence-based testimony about abortion that would have been impossible before the study was published. In your opinion, and in light of the Turnaway Study’s findings, how might your state’s abortion laws be made to better serve people seeking abortions?

16. Of the ten personal stories shared in the book, which was most impactful, eye-opening, or challenging for you and why?

Enhance Your Book Club

To further enhance your book club, please consider the following materials and resources:

Continued Reading

• Dr. Meera Shah’s You’re the Only One I’ve Told

• Annie Finch’s Choice Words

• Dorothy Roberts’s Killing the Black Body

• Katie Watson’s Scarlet A: The Ethics, Law, and Politics of Ordinary Abortion

• David Cohen and Carole Joffe’s Obstacle Course: The Everyday Struggle to Get an Abortion in America

Screening Suggestions

Dirty Dancing (1987)

The Cider House Rules (1999)

Obvious Child (2014)

Grandma (2015)

Little Woods (2019)

Never Rarely Sometimes Always (2020)

Saint Frances (2020)

Unpregnant (2020)

Documentaries

12th & Delaware (2010)

After Tiller (2013)

Ours to Tell (2020)
Photograph by Christina Samuelson

Diana Greene Foster is a professor at the University of California, San Francisco (UCSF) in the Department of Obstetrics, Gynecology, and Reproductive Sciences and director of research at Advancing New Standards in Reproductive Health (ANSIRH). An internationally recognized expert on women’s experiences with contraception and abortion, she is the principal investigator of the Turnaway Study. She has a bachelor’s of science from the University of California, Berkeley, and a doctorate from Princeton University. She lives with her husband and two children in the San Francisco Bay Area.

"A remarkable piece of research.... The Turnaway Study will be understood, criticized, and used politically, however carefully conceived and painstakingly executed the research was. Given that inevitability, it’s worth underlining the most helpful political work that the study does. In light of its findings, the rationale for so many recent abortion restrictions—namely, that abortion is uniquely harmful to the people who choose it—simply topples."
The New Yorker

"Foster’s findings are particularly relevant now, as the coronavirus pandemic, the economic downturn and ongoing efforts to restrict abortion access have made the procedure even more difficult for many to obtain."
The Huffington Post

“The Turnaway Study provides definitive evidence that abortion access strongly enhances women’s health and well-being, whereas denying abortion results in physical and economic harm. Based on a ten-year investigation, the book combines engaging, in-depth stories of women who received and were denied abortion care along with study data from 50 peer-reviewed papers published in top medical and social science journals.”
—Ms. magazine

“Required reading for anyone concerned with reproductive justice."
Kirkus, starred

"Foster’s clearheaded account cuts through the noise surrounding this contentious issue. Policy makers and abortion rights activists should consider it a must-read."
Publisher's Weekly

"Foster listens to the 'turnaway women,' and lets their stories, even more than her own scholarship, disrupt the accepted moral and political narratives that regulate access to abortion."
Library Journal

“If you read only one book about democracy, The Turnaway Study should be it.  Why? Because without the power to make decisions about our own bodies, there is no democracy.  There is no freedom and justice without reproductive freedom and justice."
—Gloria Steinem

“Dr. Foster brings what is too often missing from the public debate around abortion: science, data, and the real-life experiences of people from diverse backgrounds. Dr. Foster’s book offers the first in-depth look at the impact of being denied abortion on mental and physical health, economic wellbeing, relationships, and families. This should be required reading for every judge, member of Congress, and candidate for office — as well as anyone who hopes to better understand this complex and important issue.”
Cecile Richards, co-founder of Supermajority, former president of Planned Parenthood, and author of Make Trouble

"The Turnaway Study demonstrates the power of narrative in illuminating why women seek abortions. I have always been a feminist, and I believe we have a responsibility to safeguard reproductive rights for women everywhere--and for future generations. In this book, statistics and stories meet to reveal the consequences of denying women this service, as well as what happens when they receive it. The Turnaway Study is an essential read."
—Isabel Allende, author of A Long Petal of the Sea and The House of the Spirits

“Dispelling so many of the prevailing myths about why women seek abortion, this compelling, carefully researched, and unique study makes clear how public policies can so powerfully harm women as they make this deeply personal decision. The moving stories of real women will help illuminate for all of us – both pro-choice and anti-abortion advocates – how restrictive policies can damage the lives of women and their families and why no woman should be turned away when she seeks an abortion.”
—Judy Norsigian and Jane Pincus, authors of Our Bodies, Ourselves

"Discourse and dialogue about abortion are far too often a fact free zone, filled with emotion and ideology and bereft of the wisdom of social science. Foster has been at the forefront of changing this destructive dynamic. She has spent years studying the impact on real people and real lives of being able to access abortion services. Her work challenges how we evaluate morality in public policy--it's a must read."
—Ilyse Hogue, President, NARAL Pro-Choice America

“Our reproductive realities were the victims of fake news before the term existed, which is why Dr. Foster and her team’s work is ever more essential. With rigor and honesty, this book is an important and clarifying contribution to a reality-based conversation about abortion.”
—Irin Carmon, co-author of Notorious RBG: The Life and Times of Ruth Bader Ginsburg

“The stories and findings in The Turnaway Study are captivating and confirm what abortion funds have witnessed from their helplines for decades.  Hundreds of thousands of people calling for help across the country are navigating too many barriers to the care they need. This book illustrates that the process of obtaining an abortion is entirely too complicated and the outcomes of being denied an abortion are unjust.”
—Yamani Hernandez, Executive Director of the National Network of Abortion Funds

“The loud discourse around abortion, framed in the language of politics, religious beliefs, and women’s changing social roles, is so intense that sometimes people don’t take the time to discover the who, what, when and why of actual people making decisions and having real health and social outcomes. Dr. Foster has created an indispensable resource for scientists, policy makers, doctors, and legislators who are seeking facts to inform their opinions.”
—Dr. Stephanie Teal, Professor of Obstetrics and Gynecology, Pediatrics, and Clinical Science at the University of Colorado School of Medicine and past President of the Society of Family Planning

“The Turnaway Study reflects the ultimate in scientific methodology on this contentious subject. The rich, accurate information resonates with the poignant personal accounts. Here is the complete abortion book, both informative for health professionals and accessible to lay readers.”
—Dr. Nada L. Stotland, Professor of Psychiatry at Rush University and past President of the American Psychiatric Association

“Dr. Foster has contextualized the ground-breaking Turnaway Study using the stories of the people who are the most central to the abortion debate but whose experiences are generally overlooked: people who have abortions."
Monica R. McLemore PhD, MPH, RN, FAAN, Associate Professor of Nursing, UCSF and Chair, Sexual and Reproductive Health at the American Public Health Association